Preliminary evidence for an emerging nonmetropolitan mortality penalty in the United States

Abstract

We discovered an emerging non-metropolitan mortality penalty by contrasting 37 years of age-adjusted mortality rates for metropolitan versus nonmetropolitan US counties. During the 1980s, annual metropolitan-nonmetropolitan differences averaged 6.2 excess deaths per 100,000 nonmetropolitan population, or approximately 3600 excess deaths; however, by 2000 to 2004, the difference had increased more than 10 times to average 71.7 excess deaths, or approximately 35,000 excess deaths. We recommend that research be undertaken to evaluate and utilize our preliminary findings of an emerging US nonmetropolitan mortality penalty.

FIGURE 1—

Annual metropolitan and nonmetropolitan age-adjusted mortality per 100 000: United States, 1968–2004. Note. The Rural–Urban Continuum codes were used to classify metropolitan and nonmetropolitan counties; 1974 codes were used for 1968 to 1975, 1983 codes were used for 1976 to 1985, 1993 codes were used for 1986 to 1995, and the 2003 codes were used for 1996 to 2004. Data were derived from the National Center for Health Statistics Compressed Mortality File numbers 2A, 2E, and 2J.^–

FIGURE 2—

The magnitude of nonmetropolitan mortality disparities expressed in excess deaths per 100 000: United States, 1968–2004. Note. The nonmetropolitan mortality disparities were calculated as nonmetropolitan age-adjusted mortality per 100 000 minus metropolitan age-adjusted mortality per 100 000. Data were derived from the National Center for Health Statistics Compressed Mortality File numbers 2A, 2E, and 2J.^–